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Abstract
Delayed gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) imaging requires novel and time-efficient approaches to characterize the myocardial substrate associated with ventricular arrhythmia in patients with ischemic cardiomyopathy. Using a translational approach in pigs and patients with established myocardial infarction, we tested and validated a novel 3D methodology to assess ventricular scar using custom transmural criteria and a semiautomatic approach to obtain transmural scar maps in ventricular models reconstructed from both 3D-acquired and 3D-upsampled-2D-acquired LGE-CMR images. The results showed that 3D-upsampled models from 2D LGE-CMR images provided a time-efficient alternative to 3D-acquired sequences to assess the myocardial substrate associated with ischemic cardiomyopathy. Scar assessment from 2D-LGE-CMR sequences using 3D-upsampled models was superior to conventional 2D assessment to identify scar sizes associated with the cycle length of spontaneous ventricular tachycardia episodes and long-term ventricular tachycardia recurrences after catheter ablation. This novel methodology may represent an efficient approach in clinical practice after manual or automatic segmentation of myocardial borders in a small number of conventional 2D LGE-CMR slices and automatic scar detection.
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1 University of Valladolid, Laboratorio de Procesado de Imagen, Valladolid, Spain (GRID:grid.5239.d) (ISNI:0000 0001 2286 5329)
2 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain (GRID:grid.467824.b) (ISNI:0000 0001 0125 7682)
3 Universidad Politécnica de Madrid, Biomedical Image Technologies, ETSI Telecomunicación, Madrid, Spain (GRID:grid.5690.a) (ISNI:0000 0001 2151 2978); Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain (GRID:grid.413448.e) (ISNI:0000 0000 9314 1427)
4 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain (GRID:grid.467824.b) (ISNI:0000 0001 0125 7682); Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain (GRID:grid.414780.e); Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (GRID:grid.510932.c)
5 Philips Healthcare Iberia, Madrid, Spain (GRID:grid.510932.c)
6 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain (GRID:grid.467824.b) (ISNI:0000 0001 0125 7682); Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (GRID:grid.510932.c)
7 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain (GRID:grid.467824.b) (ISNI:0000 0001 0125 7682); Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain (GRID:grid.414780.e)
8 Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain (GRID:grid.414780.e)
9 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain (GRID:grid.467824.b) (ISNI:0000 0001 0125 7682); Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (GRID:grid.510932.c); Cardiology Department, Hospital Ruber Juan Bravo Quironsalud UEM, Madrid, Spain (GRID:grid.510932.c)
10 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain (GRID:grid.467824.b) (ISNI:0000 0001 0125 7682); Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (GRID:grid.510932.c); Cardiology Department, IIS-University Hospital Fundación Jiménez Díaz, Madrid, Spain (GRID:grid.476442.7)
11 Hospital Universitario La Paz, Cardiology Department, Madrid, Spain (GRID:grid.81821.32) (ISNI:0000 0000 8970 9163)
12 Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain (GRID:grid.414780.e); Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (GRID:grid.510932.c); Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain (GRID:grid.490176.d)
13 Barcelona Supercomputing Center (BSC), Barcelona, Spain (GRID:grid.10097.3f) (ISNI:0000 0004 0387 1602)
14 Barcelona Supercomputing Center (BSC), Barcelona, Spain (GRID:grid.10097.3f) (ISNI:0000 0004 0387 1602); ELEM Biotech SL., Barcelona, Spain (GRID:grid.10097.3f)
15 Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain (GRID:grid.414780.e); Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (GRID:grid.510932.c)